SEE INSTUCTIONS ON REVERSE 

 TICKS SCABIES IMPORT 

UNITED STATES DEPARTMENT OF AGRICULTURE 

ANIMAL AND PLANT HEALTH INSPECTION SERVICE 

VETERINARY SERVICES 

DIP SAMPLE DATA 

Send VS Form 5-14 with ea

SERVICES LABO

1920 DAYTON AVE

NAME OF PREMISES (Print or Type) CHEMICAL BRAND NAME LOCATION (City and State) TRIAL CODE ANIMAL SPECIES VAT CAPACITY 

SAMPLE ANIMALS DIPPED INITIAL CHARGE DATA REPLENISHMENT DATA STAGE SAMPLE TAKEN (“X”) FIELD TE

RESULT

NO. DATE TAKEN SINCE PREVIOUS SAMPLE TOTAL THIS BATH GALLONS OF WATER QUANTITY OF CHEMICAL ADDED INITIAL BATH VOLUME GALLONS OF WATER ADDED QUANTITY OF CHEMICAL ADDED INITIAL CHARGE BEFORE REPLEN ISHMENT AFTER REPLEN ISHMENT H P 

SUBMITTED BY (Please print or type clearly) DATE SUBMITTED FOR LABORATORY USNAME NVSL ID# 

RECEIVED FROM: POST OFFICE FEDEX OTHER 

ADDRESS CITY STATE ZIP CODE DATE RECEIVED RECEIVPHONE FAX EMAIL COLLECTOR NAME COLLECTOR ID# (i.e. 

F#) 

NVSL ACCESSION 

VS FORM 5-14 AUG 2009 
GENERAL PROCEDURES FOR TAKING DIP SAMPLES FOR QUANTITATIVE ANALYSIS 

1. Accurately determine number of gallons of water required to initially charge vat and number of gallons required to replenish bath volume at the 7/8 level or a convenient working 

if the 7/8 level is down 280 gallons from initial charge mark, one could dip down to the 300-gallon mark in order to obtain a convenient working figure. It is suggested that gaugthe number of gallons at various depths in the vat. It would be helpful to mark the sides of the vat at increments of 50 or 100 gallons and at the 7/8 level. 

It is essential that the bath volume and amount of water added be measured accurately. This can best be done by means of a calibrated water meter. It can be done by meas

counting the number of containers full (55-gallon drums, etc.) needed to charge the vat; however, these methods are subject to error. Do not accept the amount of water some

2. Fill the vat with accurately measured volume of water. On initial charge add accurate quantity of chemical to each specified number of gallons of water as directed in latest initi

charge. 

3. Mix vat contents thoroughly. Take sample from center of vat for quantitative analysis. Indicate on sample container and VS Form 5-14 that sample taken on Initial charge. 

4. When bath volume has been lowered to 7/8 level, Take Sample for quantitative analysis. Indicate on sample container and VS Form 5-14 that sample taken Before Replenis

5. At the 7/8 level replenish to original bath volume by adding accurate quantities of chemical and water as directed in latest replenishment charge instructions from veterina

and Take Sample for quantitative analysis. Indicate on sample container and VS Form 5-14 that sample taken After Replenishment. 

6. Repeat above procedures until vat is emptied, cleaned, and recharged. 7. Once the vat supervisor has achieved proper vat management as demonstrated by quantitative analysis results, the veterinarian in charge may substitute the following sam

3, 4, and 5; a bath sample at initial charge, one at the end of each day’s dipping, and another following the dipping of the last animal prior to emptying the bath. 

8. Empty, clean, and recharge the vat whenever (a) the bath becomes too foul for satisfactory use OR (b) the number of animals dipped is equal to twice the number of gallons in 

otherwise), e.g., when 6,000 animal have been dipped in a 3,000 gallon bath OR (c) the vat has been charged for a specified number of days (varies with the chemical product 

number of days for each chemical used. 

9. The bath volume level must be measured and recorded at the termination of each day’s dipping operation. This will enable the vat supervisor to accurately determine any addi

Also, during hot weather when dipping operations may have been suspended for several days, the vat supervisor may obtain an accurate measure of water loss by evaporation

loss of chemical by evaporation. Thus, if the evaporation is 50 gallons, simply add 50 gallons to correct the bath concentration. No chemical need be added. However, make 

leakage from a faulty vat. Add the appropriate replenishment quantity of chemical for any gain in the bath volume by rainfall, leaky valves, etc. By having an accurate measure better able to make accurate adjustments in the bath concentration. NOTE: An effective means of preventing rain water from entering vat should be used. 

10. The vat supervisor should make every effort to submit samples that are truly representative of the bath contents. Take samples only from a thoroughly agitated vat. Never 

sample. Take samples from center of vat – never take samples near point where drain pen empties into vat. When a bucket is used to obtain samples, immediately transfe

Do not use metal containers for shipment. Label samples properly, package them so they will arrive at destination unbroken. Include completed copy of VS Form 5-14 with ea

11. Submission Guidelines: Enter the submitter’s business name; the name of the individual submitter is optional if test results are returned to a general business fax, email, or ma

address to which we can return test results. Multiple email addresses submitters are permissible. Specify if there is a preferred method of report delivery. Provide a complete available, test reports can be mailed, but this will delay delivery of your results. Repeat submitters are encouraged to be consistent with the submitter contact information that trecord. If the test report for an individual submission needs to be routed to a non-standard destination. Include special instructions as necessary.